Media Area Unit NAACP P O Box 1973 Media, PA 19063 www.naacpmediabranch.org Black History Month Poster Contest 2015 Entry Form This must be attached with tape to the back of the poster. Student’s name ______________________________________________ Grade __________ Teacher’s name ______________________________________________ School District ______________________________________________ School ______________________________________________ Social Justice Hero ______________________________________________ Homeroom number ____________ PARENT OR GUARDIAN: COMPLETE IF YOU WISH YOUR CHILD TO PARTICIPATE Media Area NAACP invites 1st or 2nd place winners of the Black History Month Poster Contest to have a copy of their entry used for public display and/or to create a calendar, note cards, or other artifacts. I give permission for the Media Area NAACP to copy and use the 2015 poster submitted by _______________________________ for public display and/or to create articles for fundraising. __________________________________ __________________________________ (parent’s / guardian’s name) (parent’s / guardian’s signature) ___________________________ _______ (student’s signature) (date) Please cut here ____________________________ (school) ____ (grade) ----------------------------------------------------------------------------------